Breast Abscess Management and the Role of Post Incisional Antibiotics

Abstract

Introduction: Breast abscess is a common condition affecting women in the developing world, and is commonly treated with incision and drainage. Incision and drainage is associated with a long hospital stay, requires general anesthesia and daily wound care which is associated with a higher pain score and interrupts breastfeeding for puerperal cases. It is also associated with poor cosmetic results and often necessitates a return to theatre for wound closure.. The aim of the study was to describe the presentation and management of patients presenting with breast abscess at the Aga Khan University Hospital, Nairobi. Methods: We conducted a 7-year retrospective audit of all patients managed for breast abscesses at The Aga Khan University Hospital, Nairobi. Demographic data, clinical presentation, diagnosis, management and follow up were summarized. We later conducted a practice audit on the use of antibiotics for breast abscess among the delegates of a surgical conference. Results: A total of 75 patients were analyzed. Just over half (50.7%) had puerperal abscesses. The demographics, presentation and natural history do not differ between puerperal and non-puerperal abscesses. Nearly all patients (99%) underwent incision and drainage. Fifty two percent affected left breast, 45% right and 3% were bilateral. Majority of respondents of the survey used antibiotics after
incision and drainage. Conclusion: There is high rate of antibiotic use which is not backed by literature both at the institution and across the country. More needs to be done to assess if there is benefit of antibiotics after incision and drainage of breast abscesses. Tertiary level hospitals should popularize ultrasound guided aspiration for treatment of breast abscess as it may be non inferior to incision and drainage

Keywords: Breast Abscess, Image Guided Drainage, Incision and Drainage, Antibiotics